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Khirurgii

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Year 2018 Vol. 26 No 3

ANESTHESIOLOGY-REANIMATOLOGY

D.P. MARKEVICH 1, A.V. MAROCHKOV 2

FEATURES OF ELECTROENCEPHALOGRAPHIC MONITORING IN ANESTHESIOLOGICAL SUPPORT OF NEUROSURGERICAL INTERVENTIONS IN THE HEAD

Mogilev Emergency City Hospital 1,
Mogilev Regional Hospital 2, Mogilev,
The Republic of Belarus

Objective. To determine the diagnostic importance of electroencephalographic (EEG) monitoring together with different methods of anesthesia and at different stages of the surgery during neurosurgical interventions in the head.
Methods. Perioperative EEG monitoring of 34 patients operated because of the intracranial hematomas, brain tumors, and postoperative skull defects was analyzed. The first group consisted of 16 patients with the combined anesthesia (general with conductor blockades of the peripheral nerves of the scalp part of the head), the second group – 18 patients with the general anesthesia. The groups did not differ by sex, age, body weight. General anesthesia in groups was total intravenous with the mechanical ventilation with fentanyl and propofol. Blockade of nerves was performed with 0.5% bupivacaine or 0.75-1.0% ropivacaine. Cerebral state monitor was used for electroencephalographic monitoring and the cerebral state index (CSI) was monitored.
Results. There were no significant differences between CSI groups. CSI parameters at the moment of the surgery onset were 45.7±5.9 un. in 1-st group, in the 2-nd group – 54.2±17.5 un.; at trepanation: 1-st group – 51.2±15.1 un., 2-nd group – 63.1±18.3 un.; main stage of the surgery: 1-st group – 43.0±6.3 un., 2-nd group – 44.8±8.9 un.; end of operation: 1-st group – 48.1±9.9 un., 2-nd group: – 52.1±13 un.
In 5 (31.2%) patients of the 1-st group and 8 (44.4%) of 2-st group, during the skull trepanation, CSI increased more than 60 un., which required additional deepening of anesthesia by bolus injections of fentanyl and propofol.
Conclusions. There were no significant differences in CSI between the groups with the combined and general anesthesia. Taking into account the increase in CSI by more than 60 un. in 5 (31.2%) patients in the 1-st group and 8 (44.4%) of the 2-st group, preliminary additional deepening of anesthesia is necessary 3-5 minutes before the braincase trepanation.

Keywords: electroencephalographic monitoring, conductor blockades, general anesthesia, neuroanesthesiology, cerebral state index in neurosurgery, anesthetic depth monitoring
p. 348-357 of the original issue
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Address for correspondence:
212030, The Republic of Belarus,
Mogilev, Botkin Str., 2,
Mogilev Emergency City Hospital,
Anesthesiology and Intensive Care Unit.
Tel./fax: +375(222) 22-16-26,
+375(222) 29-16-42,
e-mail: snyter1977@gmail.com,
Denis P. Markevich
Information about the authors:
Markevich Denis P., Head of Anesthesiology and Intensive Care Unit, Mogilev Emergency City Hospital, Mogilev, Republic of Belarus.
http://orcid.org/0000-0002-1117-3877
Marochkov Alexey V., MD, Professor, Anesthesiologist-Resuscitator, Mogilev Emergency City Hospital, Mogilev, Republic of Belarus.
http://orcid.org/0000-0001-5092-8315
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